Abstract

Extracorporeal shockwave lithotripsy (SWL) remains the only truly minimally invasive procedure for the treatment of upper tract nephrolithiasis. Recently, there has been a recent rise in the patients on antiplatelet agents. Therefore, the aim of the present study is to review the literature available regarding SWL in these high-risk patients requiring anti-coagulation therapy. Alternative therapies to SWL are also presented.

Commentaires
1

This is a useful review of considerations to be made before ESWL and other surgical procedures in patients on anticoagulation therapy. Patients were stratified in low, intermediate and high CVD-risk groups. For the low-risk patients anti-platelet agents can be withheld for a maximum of 7 days. Substitution with unfractionated heparin was not recommended. For intermediate- and high-risk patients individualized treatment following consultation with a cardiologist is advised. For the latter groups of patients, whenever possible surgery should be postponed 6-12 month after the CVD episode. It is of particular importance to note if the patients has drug-eluting stents.

Since ESWL directed towards the renal tissue is associated with a potential risk of bleeding and that the use of anticoagulants have become so common, it is indeed important to pay attention both to the risk of not recognizing this medical treatment and to the risk of interrupting it.

This is a useful review of considerations to be made before ESWL and other surgical procedures in patients on anticoagulation therapy. Patients were stratified in low, intermediate and high CVD-risk groups. For the low-risk patients anti-platelet agents can be withheld for a maximum of 7 days. Substitution with unfractionated heparin was not recommended. For intermediate- and high-risk patients individualized treatment following consultation with a cardiologist is advised. For the latter groups of patients, whenever possible surgery should be postponed 6-12 month after the CVD episode. It is of particular importance to note if the patients has drug-eluting stents.
Since ESWL directed towards the renal tissue is associated with a potential risk of bleeding and that the use of anticoagulants have become so common, it is indeed important to pay attention both to the risk of not recognizing this medical treatment and to the risk of interrupting it.
Hans-Göran Tiselius